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The Dilnot Commission will report next week on how social care in England should be funded. Currently, if you have assets, including property, worth over £23,500 you will likely pay for social services or residential care. This means a lot of people pay for all of their care whilst some pay for none of their care.

Dilnot is charged with finding a system that will create a “fairer” system that will also encourage people to save for care that they may need. The focus will be on encouraging people to purchase insurance to cover future care costs.

The choice comes down to a voluntary insurance scheme or one where everybody has to purchase care insurance – just like all car drivers must purchase car insurance. Or there could be a voluntary scheme where people are automatically enrolled into it but can opt out.

Politicians will then be left to choose, if they choose to do anything. But what hasn’t appeared in the debate so far, is the role of genetics.

Having a certain genetic profile can make it more likely (but not certain) that you suffer conditions such as Huntingdon’s disease or Alzheimer’s. However, your behaviour can also reduce the likelihood of these so knowing your genetic profile could encourage you to change behaviour and reduce the chance of having various conditions.

Knowing can also help you and your family prepare, which is what one person felt when faced with this experience who I was talking to recently. And genetic profiling will become much more common in the future as costs rapidly decrease.

The impact of this on a care insurance market are obvious. In a voluntary insurance scheme, if you don’t have to share your genetic profile with insurance companies, those most at risk of ill health will take insurance but companies won’t know who has the greater risk so all prices will go up, fewer people will take insurance and insurance companies will leave the market. And in a voluntary system where you do have to tell the insurance company, there could be lots of people who will be refused insurance. They will be discriminated against because of their genetic profile.

However, in a compulsory insurance model where you don’t have to tell insurance companies, people will still be able to know their genetic profile and plan for the future but without fear of discrimination, and insurance companies could spread the risk and costs amongst a greater number of people.

Interestingly in 2003, the Department of Health declared: “As our understanding of genetics advances, the case for private health insurance as an alternative to our universal tax financed NHS diminishes”. It may be the same should apply to social care as well.

This is part 2 of the previous blog, so read that now if you haven’t. We established that individuals and Government have a responsibility to provide care.

The Coalition Government have created a commission to look at the funding of care and support in England. A chief consideration will be creating either a mandatory or voluntary insurance scheme whereby you pay in advance of having care needs and the policy will cover the costs of your support needs that are not met by the Government’s contribution.

So, I pay £20 p/m and then when I’m 75 and need support to live at home or residential care, my insurance company will cover the costs (let’s assume reasonable insurance companies for this blog’s purpose). Sounds simple.

But what if my wife (this isn’t a public proposal Mum) decides that she would like to care for me and doesn’t care that the insurance wouldn’t pay her to do it? We’ve just paid all that money for no reason. This could lead to two things:

1. Fewer people provide care because they feel as though the insurance company, or Government if it is publicly run, should pay for all care

2. People don’t pay for insurance because they expect to receive family provided care

Let’s start with the first scenario. Fewer people caring increases demand on paid care, pushing up costs of the system. This is bad news for a Commission that is trying to create a more sustainable system because of projected funding gaps. If carers currently provide £87bn worth of care, the system could very quickly become completely unsustainable if families stop caring.

But the second scenario doesn’t look good either. This would increase the demands on families to provide care when we already know there is too much pressure on them currently.

The solution to overcome these problems must encourage and account for families who are providing care.

There is no way of knowing how much informal care you will receive whilst paying your insurance, which is generally before you have support needs. So the only way to recognise the caring contribution is by giving rebates to families when they are providing care.

Does this solve the problem? Not quite. How much do you decide to give them?

It’s another ‘to be continued’ as the next blog will look at this question.